title: Topical treatments for chronic plaque psoriasis of the scalp: a systematic review.
abstract: BACKGROUND
  Chronic plaque psoriasis is the most common type of psoriasis and is characterized by redness, thickness and scaling. First-line management is with topical treatments.
  
  
  OBJECTIVE
  Our objective was to establish the effectiveness, tolerability and safety of topical treatments for people with chronic plaque psoriasis of the scalp, assessing placebo-controlled trials of all treatments and head-to-head trials that assessed vitamin D analogues.
  
  
  METHODS
  As part of a Cochrane review of topical treatments for psoriasis, we systematically searched electronic databases for randomized controlled trials. The review included 26 randomized controlled trials of treatments for psoriasis of the scalp with 8020 participants. Trials used several measures to assess changes in psoriasis severity: these were combined using the standardized mean difference metric and interpreted by reporting as a six-point global improvement score.
  
  
  RESULTS
  On effectiveness grounds, very potent or potent steroid treatments should be preferred to vitamin D3 analogue with approximately an average 10% additional improvement on a six-point scale. Vitamin D3 analogue combined with potent steroid appears slightly more effective than potent steroid monotherapy (3% additional improvement on a six-point scale). Rates of withdrawal from treatment and adverse events in trials were generally low and similar to those for placebo. There remains uncertainty about the atrophic potential of corticosteroid treatments for scalp psoriasis.
  
  
  CONCLUSIONS
  Corticosteroids are more effective than vitamin D analogues and similarly tolerated. However, further research is needed to inform long-term maintenance treatment and provide appropriate safety data.
authors.affiliation: Centre for Health Economics, University of York, York, YO10 5DD, U.K.
authors.forename: A R
authors.initials: AR
authors.lastname: Mason
authors.forename: J M
authors.initials: JM
authors.lastname: Mason
authors.forename: M J
authors.initials: MJ
authors.lastname: Cork
authors.forename: H
authors.initials: H
authors.lastname: Hancock
authors.forename: G
authors.initials: G
authors.lastname: Dooley
mesh_terms: D000279:Administration, Cutaneous; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D002762:Cholecalciferol / Q000009:adverse effects / Q000031:analogs & derivatives*; D002908:Chronic Disease; D003879:Dermatologic Agents / Q000008:administration & dosage*; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012536:Scalp Dermatoses / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D003879:Dermatologic Agents; D002762:Cholecalciferol